Annals of Surgical Oncology

, Volume 20, Issue 4, pp 1336–1340

Toxic Nodular Goiter and Cancer: A Compelling Case for Thyroidectomy

  • J. Joshua Smith
  • Xi Chen
  • David F. Schneider
  • Ratnam Nookala
  • James T. Broome
  • Rebecca S. Sippel
  • Herbert Chen
  • Carmen C. Solorzano
Endocrine Tumors

DOI: 10.1245/s10434-012-2725-4

Cite this article as:
Smith, J.J., Chen, X., Schneider, D.F. et al. Ann Surg Oncol (2013) 20: 1336. doi:10.1245/s10434-012-2725-4

Abstract

Background

Recent American Thyroid Association guidelines call for thyroidectomy or 131I (Recommendation 31) in managing hyperthyroidism due to toxic nodular goiter (TNG). Concern for concomitant malignancy favors surgery. A 3 % thyroid cancer incidence in TNG patients has been reported, yet recent studies suggest this rate is underestimated. This multi-institutional study examined cancer incidence in TNG patients referred to surgery.

Methods

Patients referred for thyroidectomy at three tertiary-care institutions were included (2002–2011). Patients with concurrent indeterminate or malignant diagnosis by fine-needle aspiration (FNA) were excluded. Cancer incidence in TNG patients was determined. Fisher’s exact and chi-square tests and nonparametric t tests were used.

Results

Among 2,551 surgically treated patients, 164 had TNG (6.4 %). Median age at presentation was 49.7 years, and 86 % were female. Overall cancer incidence was 18.3 % (30 of 164), and rates were not significantly different between institutions. A significantly greater cancer rate was noted in toxic multinodular goiter versus single toxic nodule patients (21 vs. 4.5 %, P < 0.05). Mean tumor size was 0.71 cm (range 0.1–1.5 cm; 23 % ≥1 cm). Most patients underwent total or near-total thyroidectomy. There were no significant differences in tumor sizes among institutions (P > 0.05). No significant cancer association was noted with age, preoperative dominant nodule size, lymphocytic thyroiditis or preoperative FNA (P > 0.05).

Conclusions

These data demonstrate a higher than expected incidental cancer rate in TNG patients compared to historical reports (18.3 vs. 3 %). This higher cancer incidence may alter the risk/benefit analysis regarding TNG treatment. This information should be provided to TNG patients before decision making regarding treatment.

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • J. Joshua Smith
    • 1
    • 2
  • Xi Chen
    • 3
    • 4
  • David F. Schneider
    • 5
  • Ratnam Nookala
    • 1
  • James T. Broome
    • 1
    • 3
    • 6
  • Rebecca S. Sippel
    • 5
  • Herbert Chen
    • 5
  • Carmen C. Solorzano
    • 1
    • 3
    • 6
    • 7
  1. 1.Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.Vanderbilt Medical Scientist Training Program, Clinical Investigator TrackVanderbilt University Medical CenterNashvilleUSA
  3. 3.Vanderbilt-Ingram Cancer CenterVanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of BiostatisticsVanderbilt University Medical CenterNashvilleUSA
  5. 5. Division of General Surgery, Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  6. 6.Division of Surgical OncologyVanderbilt University Medical CenterNashvilleUSA
  7. 7.Division of Endocrine SurgeryUniversity of Miami Miller School of MedicineMiamiUSA

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